College of Medical Technology, Zhejiang Chinese Medical University, 548 Bingwen Road, Hangzhou.
Department of Clinical Laboratory, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou.
Medicine (Baltimore). 2021 Jan 22;100(3):e23935. doi: 10.1097/MD.0000000000023935.
Unlike Western countries, there are still few clinical immunology specialists in China, and the optimal care for secondary immunodeficiency caused by hematological malignancies is unknown. Therefore, we initiated this clinician survey study to describe the current situation of the care for malignancy patients with hypogammaglobulinemia in China.We adapted a previously published online questionnaire of current clinical practices regarding the management of secondary immunodeficiency caused by hematological malignancies and then distributed the questionnaire to 52 hematologists in China via WeChat mobile software; the survey collected demographic details, starting dosage, target immunoglobulin (Ig) level, monitoring, criteria for stopping Ig replacement, vaccination use, and oral antibiotic prophylaxis for hypogammaglobulinemia patients.Forty-eight hematologists responded. 28(58.33%) respondents had more than 10 years of experience. Nevertheless, 40(83.33%) respondents reported that they did not use any specific criteria for prophylactic Ig replacement in hypogammaglobulinemia patients. However, 27(56.25%) respondents reported that they had used intravenous immunoglobulin (IVIG); however, the starting dose, frequency, and target Ig level were significantly varied. Additionally, the criteria for stopping Ig replacement were significantly varied. Only one respondent (2.08%) used subcutaneous immunoglobulin (SCIG). Moreover, 35(72.92%) respondents reported no vaccination prior to Ig replacement, and 47(97.92%) respondents reported that they had not used antibiotic prophylaxis in secondary hypogammaglobulinemia patients.Official guideline for the care for secondary immunodeficiency (SID) of the hematological malignancies patients should be issued in China, and significant attention of the hematologists should be paid to the use of prophylactic antibiotics and Ig replacement for the care of patients with hypogammaglobulinemia caused by hematological malignancies, as these agents could significantly reduce the infection rate in China.
与西方国家不同，中国仍缺乏临床免疫学专家，对血液系统恶性肿瘤引起的继发性免疫缺陷的最佳治疗方法尚不清楚。因此，我们开展了这项临床医生调查研究，以描述中国血液系统恶性肿瘤低丙种球蛋白血症患者的治疗现状。我们借鉴了之前发表的一份关于血液系统恶性肿瘤继发免疫缺陷管理的在线调查问卷，并通过微信移动软件向中国的 52 位血液科医生发放问卷；该调查收集了人口统计学细节、起始剂量、目标免疫球蛋白（Ig）水平、监测、停止 Ig 替代治疗的标准、疫苗接种和低丙种球蛋白血症患者的口服抗生素预防情况。48 位血液科医生做出了回应。其中 28 位（58.33%）医生有超过 10 年的从业经验。尽管如此，40 位（83.33%）医生表示，他们没有为低丙种球蛋白血症患者预防性 Ig 替代治疗使用任何特定标准。然而，27 位（56.25%）医生表示他们曾使用过静脉注射免疫球蛋白（IVIG）；然而，起始剂量、频率和目标 Ig 水平存在显著差异。此外，停止 Ig 替代治疗的标准也存在显著差异。只有一位医生（2.08%）使用过皮下免疫球蛋白（SCIG）。此外，35 位（72.92%）医生表示在 Ig 替代治疗前没有进行疫苗接种，47 位（97.92%）医生表示没有在继发性低丙种球蛋白血症患者中使用抗生素预防。中国应发布针对血液系统恶性肿瘤患者继发性免疫缺陷（SID）治疗的官方指南，血液科医生应高度重视预防性抗生素和 Ig 替代治疗在血液系统恶性肿瘤相关低丙种球蛋白血症患者中的应用，因为这些药物可以显著降低中国的感染率。
